Repeat testing for chlamydia trachomatis, a “safe approach” to unsafe sex? a qualitative exploration among youth in Stockholm

Abstract

Background Chlamydia trachomatis testing is offered to youth in Sweden, through a network of Youth Health Clinics, free at the point of care, in an attempt to bring down the prevalence and incidence of the infection. Nevertheless, infections rates have continued to rise during the past two decades and re-testing rates among youth for Chlamydia trachomatis has been reported to be high in Stockholm County. A few literature reports suggest that testing for sexually transmitted infections and the test result itself can have an undesirable impact on the sexual behaviour for the individual, i.e. increase sexual risk-taking.MethodsThis qualitative study aimed to explore the motives for repeated testing for Chlamydia trachomatis among youth using the services of the Youth Health Clinics in Stockholm, and how testing affects their subsequent risk-taking. We interviewed 15 repeat testers aging 18–22 years.ResultsOur main findings were that the fear of social stigma related to infecting a peer was a major driver of the re-testing process. The repetitive testing process, the test result, and the encounter with personnel did not decrease sexual risk-taking among this group.ConclusionsWhile testing and treatment services are an important part of Chlamydia trachomatis prevention it must not take the focus away from primary prevention strategies. Testing should be encouraged, but not to the exclusion of risk reduction measures. The testing services must be complemented with stronger emphasis on safe sex, especially for those who attend the clinics repeatedly, otherwise the easy accessible testing services risk counteracting its own purpose. Future research should focus on developing and evaluating youth appropriate interventions to increase condom use, taking into consideration factors which youth perceive as important to drive this behaviour change.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2681-6) contains supplementary material, which is available to authorized users.

‘Repeat testing without having ‘the talk’ is not meaningful’—healthcare providers’ perceptions on finding a balance between Chlamydia trachomatis testing and primary prevention strategies. A qualitative study in Stockholm, Sweden

“…HCPs viewed this as an opportunity to reach youth with primary prevention strategies. The notion that re-testing is as safe as using a condom was previously reported by our research team 22 and was confirmed by HCPs in the present study.…”

“…Findings in the present study were also triangulated with findings from a previous study. 22 Peer debriefing was conducted to validate our finding with other researchers.…”

“… 21 HCPs highlighted that accessibility to testing services might lessen responsibility on the individual for their own behaviour. The understanding by youth that testing is as safe as using condoms has negative effects on condom use, 22 and this is why testing without problematising this behaviour was perceived as meaningless. Before scaling up accessibility to testing and re-testing services around the globe, ‘testing as prevention’ should be taken into account.…”

“… 21 One explanation is that re-testers used repeat testing as a substitute for condom use, that is, testing for C. trachomatis was viewed by them as a means of prevention. 22 The notion of ‘repeat testing to stay safe’ has not previously been explored among healthcare providers (HCPs). In order to create a successful programme for C. trachomatis prevention and control, it is important to consider the experience and opinions of frontline HCPs who interact with youth in their everyday work.…”

Patterns of Sexual Behaviour Associated with Repeated Chlamydia Testing and Infection in Men and Women: A Latent Class Analysis

“…Repeated testing after chlamydia infection due to unchanged risky behaviour has been discussed elsewhere [19,52,20,53]. It was recently reported that young adults who engage in unsafe sex possibly have repeated tests for chlamydia as a replacement for condom use [54]. The same study found that repeated testing gave a false sense of security when the chlamydia test was negative, while a positive chlamydia test resulted in repeated testing, but did not encourage changes in sexual behaviour [54].…”